LAFAYETTE — Tippecanoe County Health Department is awaiting the return of 2,148 syringes supplied as part of its needle exchange program, according to a report obtained by the Journal & Courier.

As of Sept. 31, the most recent date for which data were available, the needle exchange had served 83 people and had supplied 4,475 syringes, of which 2,327 — or 52 percent — were returned since the program opened its doors in August, according to a quarterly report submitted to the Indiana State Department of Health.

The report was furnished after a public records request and a two-week investigation by the J&C, which followed a Lafayette man addicted to heroin through his first two visits to the needle exchange program.

Jeremy Adler, Tippecanoe County's health officer, said "the rather large discrepancy" is "pretty typical" for a young program.

"I would expect that gap that you see right now — the difference between the number of syringes out and the number returned — that gap is going to shrink over time as the program ages because you'll have a lower ratio of new to returning participants," Adler said. "You'll be more in a pure exchange mode, which is more of a steady state."

Some aspects of the program have been opposed by mayors, police chiefs and other officials in Lafayette and West Lafayette, who have called for a mandated one-to-one exchange to ensure dirty needles do not wind up in parks or other public places.

But until this week, the health department had not released the exact number of syringes issued and collected as part of the program.

The sought-after statistics, which had not been shared with the public or local authorities, support the first-hand account of the J&C's source, who returned half of the needles supplied on his first visit and was given 50 more on his second trip.

Lafayette police Chief Patrick Flannelly said his concerns at the inception of the program remain the same.

"I still think there needs to be tighter guidelines on this program. ... Did we give out a needle and did we get one back?" Flannelly said. "And if we didn’t get one back, where are they going?"

In its breakdown of the quarterly report, however, the health department said the return rate was even better: 117 percent.

But the agency's equation does not account for the estimated 2,490 syringes issued on a person's initial visit, only the estimated 1,985 needles issued on a person's return visit.

"(People) are thinking this is an exchange program, therefore whatever somebody brings in, they're going to get that number back, or close to it, which is what will happen as the program gets older and that ratio of new to returning participants decreases," Adler said. "But at the beginning, you have the number of syringes given out to folks because when they're new to the program, they're not coming in with a bucket of syringes. Most of them come in with none."

Lafayette Mayor Tony Roswarski said the health department's calculation of a return rate isn't consistent with what the community expected.

"That’s not an accurate reflection of what the return rate is," Roskwarski said. "We need to know from day one how many needles were passed out and how many needles we had returned to this point ... That to me requires more explanation. This should be done in a way that any citizen ... should be easily able to understand what's taking place."

Give and take

The health department can only estimate the number of collected syringes, which are returned in sealed sharps containers, because staff do not individually count each one for safety purposes.

Adler said staff also will begin weighing containers for a more accurate count.

"They're counted through the lid, so when you're counting, you can get a good number but could it be off by a few needles? It's possible," he said. The state does "not want anybody opening these containers up and doing actual counts because that’s just too dangerous. That’s putting people at risk of accidental needle sticks and illness."

West Lafayette police Chief Jason Dombkowski said he questioned the health department's presentation last month after his officers found a trove of needles in September.

A man living in a homeless camp near Tapawingo Park was arrested after police found more than 70 uncapped, used needles from the exchange on the ground around him, Dombkowski said.

"I questioned that number (presented to the city council) based on the facts that we had upon arresting people in possession of needles," he said. "And I have later discovered that the return program is just an estimate, it's not an actual accounting system."

He added there should be "accountability for each and every needle that is handed out in the program ... It looks like about half the needles they’ve given away are still out in the community."

The health department hosts a weekly cleanup in the Centennial Neighborhood to canvas for dirty needles and has found only one, Adler said.

The program's goal first and foremost is to stem the number of dirty syringes among people who abuse heroin, reducing the prevalence of hepatitis C due to needle sharing.

Cases of hep C jumped 20 percent in a five-year period from 2011 to 2015, according to a recent report by the state department of health.

Seventeen people in the program have been identified as hep C positive, while 65 percent of participants overall were tested for the deadly disease, according to the quarterly report.

Flannelly said he wished baseline testing was required to track if the program is cutting into the hep C epidemic, which was declared a public health emergency last year.

He added that the statistics don't show if clients are local or from out of town, or if they are minors.

"From their numbers, it still doesn't appear we have a good idea of the people that they're giving the needles to," he said. "Without some basic requirements for utilization of the program, we can't accurately measure whether the program is effective or not."

"We are not able to verify addresses," he said. "In terms of age, we ask them if they're 18 or older, so it’s the honor system. Clearly, if somebody appears to be younger than 18, of course that’s going to call into question. You might ask for additional proof of their age."

Part and parcel

Among the program's success stories were two people who quit using heroin altogether, while another estimated 12 people "actively engaged in formal or informal substance abuse treatment," according to the quarterly report.

But Dombkowski said another aspect of the program — providing 34 doses of Narcan, an anti-overdose medication — could enable people with substance abuse disorders.

"Narcan by itself encourages drug use, as does the rest of the kit," he said. "In my view, it does nothing to curb the spread of the disease. The Narcan component alone, that part of the giveaway program has nothing to do with disease control."

With Narcan freely available, many people who overdose might not get the proper medical attention, Flannelly said.

"When we give Narcan away in those kits, people could be (overdosing) and then never calling for medical intervention or for law enforcement intervention," Flannelly said. "It's good to have a lifesaving tool out there for people but the question becomes: Are we doing our best, are we doing everything we can to get people treatment? Or are we just continuing to enable a population to do what they're doing anyway?"

Partnerships with police and other public safety personnel is among the program's toughest challenges, health department staff wrote in the quarterly report.

"Another challenge is how to handle arrests and police questioning," the report states. "We would like to come together with public safety to form a better bond, but that is not happening."

Adler said he was not aware of people being targeted simply for their participation in the program.

Clients "have not been arrested for simply using this program, as far as I know," he said. "The state law that allows these program to exist prohibits that. It does not prohibit those individuals from being arrested for any other illegal activities."

Authorities in Lafayette and West Lafayette said they're not against the program and are willing to collaborate but would like it to be more transparent.

A potential partnership, however, can only go so far.

"If anyone in our community is in possession of heroin, they will be arrested and they will be incarcerated at the Tippecanoe County Jail," Dombkowski said, "whether they're part of the needle exchange program or not."